Perspectives on substance-related disorders
I. Substance intoxication
    A. Reversible substance-specific syndrome due to recent ingestion or exposure
    B. Maladaptive behavioral or psychological changes due to the effect of the substance
    C. Not due to medical condition or accounted for by mental disorder

II. Substance abuse
    A. Maladaptive pattern of use leading to impairment or distress as manifested by one or more of the following during the same 12-month period
        1. Recurrent use resulting in failure to fulfill major obligations - neglect of children, job, school, family
        2. Use in situations where it is hazardous
        3. Substance-related legal problems- DUI, disorderly conduct
        4. Continued use despite social or interpersonal problems

    B. Symptoms do not meet criteria for substance dependence

III. Substance dependence
    A. Maladaptive pattern of use leading to impairment or distress as manifested by three or more of the following during the same 12-month period
        1. Tolerance
            a. Need for increased amounts to achieve desired effect
            b. Diminished effect with continued use of the same amount
        2. Withdrawal
            a. Characteristic withdrawal syndrome for the substance
            b. Use of the same or similar substance to avoid withdrawal symptoms
        3. Taken in larger amounts or over longer period than intended
        4. Persistent desire or unsuccessful efforts to cut down or control use
        5. Great deal of time spent on activities necessary to obtain the drug, use the drug, or recover from effects
        6. Giving up important social, occupational, or recreational activities because of use
        7. Use is continued despite knowledge or having physical or psychological problem likely to be caused or exacerbated by the substance

Specify if:
with physiological dependence - tolerance or withdrawal
with psychological dependence - no tolerance or withdrawal

IV. Types of Substances
    A. Depressants
        1. Alcohol
            a. Statistics

    B. Sedatives
        1. Barbiturates

    C. Stimulants
        1. Amphetamines
        2. Cocaine

    D. Nicotine

    E. Opiates
        1. Opioids

    F. Cannabis and Hallucinogens
        1. Marijuana
        2. LSD, psilocybin, mescaline , PCP

V. Statistics and Course

    A. Age of Onset

    B. Patterns of Use

    C. Gender Differences
 

VI. Causes of Substance Related Disorders

    A. Biological
        1. Genetic and familial
            a. Keep in mind that to develop an addiction:
                i. Drugs have to be available
                ii. Genetically vulnerable person must choose to use
                iii. Vulnerability does not automatically lead to dependence

            b. Genetic link
            c. Neurobiological

        2. Psychological dimensions
            a. Positive reinforcement
            b. Negative reinforcement
                i. Stress reduction
                ii. Negative affect
                iii. Self-medication
                iv. Opponent process theory

        3. Social and cultural dimensions
            a. Learning at home
            b. Indirect learning
            c. Culture

VII. Treatment
     A. Focus
        1. Help with withdrawal
        2. Maintain low level of use
        3. Prevention from exposure
        4. Trading addictions
 
    B. Biological
        1. Agonist substitution
        2. Antagonist treatment
        3. Aversive treatments

    C. Psychosocial treatments
        1. Inpatient hospital treatment
        2. Alcoholics or Narcotics Anonymous
        3. Controlled use
        4. Relapse prevention
        5. Aversion therapy

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